“I have been in a wheelchair from January after a big stone fell on my back in a mine accident. They said I am paraplegic now ... I am married ... I have two children...My problem is one – I cannot stay hard enough to do many rounds like before. Also sometimes my penis sleeps while I am still busy ... I am worried my wife will leave me to find a man who is stronger with sex.. Please help me to make better sex”
Erectile dysfunction, or ED, is the inability to produce an erection of sufficient strength or duration to initiate or complete intercourse. It is the most common problem relating to male sexual dysfunction and is not limited to persons living with a disability but able bodied men as well.
The most common causes of ED are pre-existing Diabetes, problems with circulation of blood or heart disease, excessive intake of alcohol, smoking and high stress levels. Very often a combination of these factors are present, coupled with the natural aging process.
The above factors also apply to a person who sustains a spinal cord injury but the injury itself often causes further difficulties in getting and keeping an erection.
Men normally have two types of erections. The brain is the source of psychogenic erections. The process begins with sexual thoughts or seeing or hearing something stimulating or arousing. Signals from the brain are then sent through the nerves of the spinal cord. The signals are relayed to the penis and this triggers an erection.
A reflex erection occurs with direct physical contact to the penis, scrotum or other erotic areas such as the ears, nipples or neck. A reflex erection is involuntary and can occur without sexually stimulating thoughts.
An erection is usually maintained during intercourse by continuous psychogenic and reflex stimulation brought on by touch and sight senses.
If you are a paraplegic with a lower level injury you should retain the ability to have a psychogenic erection as well as a reflex erection.
If your erection does not last long enough the cause may be related to your concern regarding your ability to have adequate sexual intercourse. This is referred to as performance anxiety and often contributes to existing problems to get and keep an erection.
There are several options available to address ED in South Africa but they are all relatively expensive and cannot yet be claimed for on medical aid benefit scales.
The first treatment option to look at is oral medication, phosphodiesterase inhibitor pills, such as Viagra , Cialis or Levitra. These pills work by increasing blood flow to the penis to improve erectile function.
You will not get an erection just by taking the pill. Sexual stimulation is also required for an erection. Once a man has completed sexual activity, blood flow to the penis would decrease and his erection should go away. The pills can only be prescribed by your general physician as certain circulatory or heart conditions exclude their use.
Other treatment options are available for those who do not respond to, or cannot take, the oral medication. These treatment options also have associated risks to consider, so it is important to talk to a doctor for more information.
Penile injection therapy involves injecting a drug, or combination of drugs, into the side of the penis. This produces a hard erection lasting for several hours. These drugs must be managed exactly as prescribed by the physician. This method is not recommended for use more than once a week. A penile injection is a difficult option for a man with limited hand function (due to spinal cord injury) but in your case this should not present a problem as it sounds as if you have a relatively low injury.
A vacuum pump is a mechanical option for producing an erection sufficient for intercourse.
The penis is placed in a vacuum cylinder and the air is pumped out of the cylinder. This causes blood to be drawn into the erectile tissue of the penis and at the same time a constrictive ring is drawn onto the base of the penis preventing blood from escaping. The device produces a strong erection but the constrictive ring must be removed after approximately thirty minutes to allow blood circulation to normalize. After an interval of a few minutes you may use the device again allowing you to go ‘as many rounds as you wish”.The vacuum pump is a popular option as it produces erections on demand and, although the initial cash outlay is relatively high, continued use of the device means it will soon pay for itself as compared to other options where costs are incurred with every use.
You mention in your letter that you fear your wife may leave you for a ‘stronger man’. This is probably the most common fear expressed by men who have recently become disabled through spinal cord injury. I have been working in this field for many years and I have many recorded case histories of men expressing exactly this fear.
It is however a fact that women value a number of other factors besides sexual intercourse when it comes to maintaining a relationship.
Considerations of mutual respect, love, being genuine, dedication and companionship rank equally in importance and are not directly reduced by spinal cord injury.
If you had a relationship with your wife before that was satisfying besides your sex life, there is no reason why this relationship cannot continue for the same reasons.
You will then find in your partner a friend and an ally who can work with you to find new ways to meet the challenge and to make your sex life exciting and satisfying again.